The Washington PostDemocracy Dies in Darkness

Fewer Americans had health insurance last year before pandemic struck, Census Bureau report shows

Although the reasons are sharply debated, the new data signifies that the first three years of President Trump’s tenure were a period of contracting insurance coverage

(Spencer Platt/Getty Images)

Health insurance became slightly more scarce in the United States last year, even before the coronavirus pandemic arrived and stole the jobs and health benefits of millions of Americans, according to federal data released Tuesday.

Nearly 30 million people in the country lacked coverage at some point during 2019, 1 million more than in the previous year. Last year marked the third year in a row that the ranks of the uninsured swelled, according to a U.S. Census Bureau report regarded as the most solid depiction of the nation’s health insurance landscape.

Still, the new findings provide contrasting images of Americans’ financial well-being, also showing that the proportion of people living in poverty reached a record low in 2019. According to the Census Bureau figures, the official poverty rate fell to 10.5 percent last year — the lowest in six decades that such figures have been tracked and the fifth consecutive annual decline in the national poverty rate.

Poverty rates decreased for all major racial and ethnic groups, with the poverty rate for Blacks falling to 18.8 percent and that for Hispanics falling to 15.7 percent. Still, those measures remained well above the poverty rate for Whites, at 9.1 percent.

Meanwhile, median household income jumped to its highest recorded level. But income and poverty levels are expected to have worsened markedly this year as the pandemic has wreaked havoc on the economy and millions of Americans have lost their jobs.

The recession is over for the rich, but the working class is far from recovered

Though the reasons are sharply debated, the new data signifies that the first three years of President Trump’s tenure were a period of contracting health insurance coverage. The decreases reversed gains that began near the end of the Great Recession and accelerated during early years of expanded access to health plans and Medicaid through the Affordable Care Act — the sprawling law that was a signature domestic achievement of President Barack Obama and has been derided by Republicans, including Trump, ever since.

“President Trump has been unsuccessful in repealing the ACA, but he has taken steps to weaken the law and that are showing up in these numbers,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. Those steps including allowing states to make it harder for people to renew Medicaid coverage or get it retroactively and slashing aid for encouraging people to sign up for ACA health plans. Enrollment in those health plans declined by 1 million last year, the Census Bureau figures show.

Trump and other Republicans have long insisted that the law has simply failed.

The erosion of coverage left more people exposed to the burden of medical costs — and potentially rendered some of those infected reluctant to seek care once the pandemic hit. That erosion “disproportionately” affects Black and Hispanic Americans, said Dan Mendelson, founder of Avalere Health, a D.C.-based consulting firm. Nearly 17 percent of Hispanics and nearly 10 percent of Blacks lacked coverage throughout last year — far higher than among Whites and Asians.

“This only exacerbated the awful disparities in care we see,” Mendelson said. “The numbers this year are not especially dramatic, but just wait until next year.”

The Census Bureau findings are laden with political significance, given that polling consistently has shown health care as among the most prominent issues on voters’ minds ahead of the presidential election less than two months away. And the pandemic — with over 6.5 million reported coronavirus cases in the United States and deaths approaching 200,000 — has focused attention on the importance of being able to afford health care when sick.

As has been true historically, the majority of people with health insurance received it through their job — 55.4 percent. That is a slight increase from the 55.2 percent with employer-provided coverage the previous year.

The findings show Americans’ reliance on public insurance programs was a mixed picture last year. The proportion insured through Medicaid, the insurance for lower-income Americans that is a shared responsibility of the federal government and states, fell a bit, from 17.9 percent in 2018 to 17.2 percent. The share using Medicare, the federal insurance for Americans who are 65 and older or disabled, rose from 17.8 percent in 2018 to 18.1 percent, largely because the population of older people is expanding.

Medicaid rolls swell amid the pandemic’s historic job losses, straining state budgets

Tuesday’s data also showed that median U.S. income — the point at which half of U.S. families earn more and half earn less — rose to $68,703, up 6.8 percent from the 2018 median of $64,324. Rising employment and broad-based wage increases in 2019 helped drive that uptick, Census Bureau officials said in a call with reporters.

The 2019 data offers a final snapshot of the United States’ record-long economic expansion, which came to a sudden and devastating end with the pandemic. By the end of 2019, the unemployment rate was at a 50-year low of 3.5 percent. Women outnumbered men in the workforce for only the second time, buoyed by a tight labor market and fast job growth in health care and education. Minimum-wage increases were also fueling faster wage growth for those at the bottom.

Those historic gains also meant that some Americans long marginalized from the workforce were increasingly able to join it.

As permanent economic damage piles up, the Covid Crisis is looking more like the Great Recession

Since March, however, job losses have disproportionately hit low-income workers and women, many of whom held service-sector jobs that were gutted by shutdown measures to help protect people from infection. Nearly 40 percent of households with income below $40,000 were laid off or furloughed by early April, according to the Federal Reserve.

Meanwhile, even before the recession brought on by the pandemic, the Census Bureau findings show that the nation’s long-standing income inequality persisted last year, though it did not widen significantly from 2018. Households with the top one-fifth of earnings accounted for almost 52 percent of all income earned in the United States — more than the bottom four-fifths combined. The poorest one-fifth of households received 3 percent of all income.

While the Census Bureau data portrays the year preceding the novel coronavirus, the pandemic affected one of the two surveys the bureau released Tuesday, according to bureau officials who described the findings on a call with reporters. Typically, the Current Population Survey, the bureau’s oldest survey, is considered the best measure of overall insurance patterns. It shows who lacked insurance throughout a given year. But the officials said survey responses plummeted early this spring, distorting the findings, so they recommended relying this year on another survey for overall insurance findings, the American Community Survey, which asks respondents whether they have coverage at the time they are interviewed.

The Current Population Survey data, with the flawed response rate, shows a slight decrease in people uninsured throughout last year.

The American Community Survey also is better for showing insurance data at the state level. In 2019, it shows, the only state in which the percentage of people without health insurance declined was Virginia, where it fell by nearly 1 percent after the commonwealth expanded its Medicaid program at the start of that year. The ranks of the uninsured grew in 19 states and did not change statistically in the rest.

The Census Bureau also had to account for response-rate issues affecting the national poverty rate. In a blog post, the bureau said that adjusting for non-response, the poverty rate in 2019 would have been 11.1 percent instead of the official estimate of 10.5 percent.

Heidi Shierholz, senior economist and director of policy at the Economic Policy Institute, said the undercount of people in poverty was probably over 2 million. And when there are undercount issues, Shierholz said, people at the lowest income brackets and people of color tend to be affected the most. For example, lower-income Americans may have less stable addresses or phone numbers, or it might take more time and investment to build trust with a survey-taker.

“It’s not trivial,” Shierholz said. “It doesn’t change the broader story in these numbers … and the Census Bureau is being super transparent about this issue. But it’s an issue.”